Baseline Assessment

Social Skills Questionnaire
Rating Key: 1-Does not perform; 2-Partial performance; 3-inconsistent performance; 4-consistent performance

1. Smiles, nods, or says “you’re welcome” when told “thank you”	1 2 3 4
2. Uses good manners, including saying “please,” “thank you”, and “sorry” when appropriate	1 2 3 4
3. Apologizes for unintentional mistakes	1 2 3 4
4. Obtains items that are out of reach appropriately (e.g. asks/points rather than reaching over)	1 2 3 4
5. Asks permission in contexts where it is expected (leaving the room, using some one else’s possessions)	1 2 3 4
6. Waits for turn in group activities	1 2 3 4
7. Shares materials without being reminded	1 2 3 4
8. Asks permission to use objects or materials being used by another	1 2 3 4
9. Uses nonaggressive words and actions	1 2 3 4
10. Handles frustration when experiencing difficulties with school tasks/activities	1 2 3 4
11. Resolves ordinary peer conflicts or problems adequately on his/her own without requesting teacher assistance	1 2 3 4
12. Offers to help another person	1 2 3 4
13. Listens/pays attention while others in group are speaking	1 2 3 4
14. Waits turn to speak	1 2 3 4
15. Listens to others and contributes own ideas	1 2 3 4
16. Responds appropriately to social interaction by peer	1 2 3 4
17. Initiates conversations appropriately	1 2 3 4
18. Makes positive comments to peers	1 2 3 4
19. Sustains conversation through several exchanges	1 2 3 4
20. Works cooperatively with other students on all aspects of a multiple step, goal-directed activity	1 2 3 4

Adapted from:
Coster, W. Deeney, T., Haltiwanger, Haley, S. (1998). School Function Assessment (SFA). Boston: The Psychological Corporation.